{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T23:23:29Z","timestamp":1787354609034,"version":"build-2736575974"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Endoscopic retrograde cholangiopancreatography-guided transpapillary biliary drainage (ERCP-BD) is the standard for primary palliation of malignant distal biliary obstruction (MDBO), but endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has demonstrated improved technical success, efficiency, and safety in randomized trials. However, cost-effectiveness data are lacking. In this modeling study, we analyzed the cost-effectiveness of EUS-CDS with lumen-apposing metal stent (LAMS) and ERCP-BD with self-expandable metal stent (SEMS) for primary MDBO palliation.<\/jats:p>\n                  <jats:p>A state-transition Markov model compared EUS-CDS and ERCP-BD over a 1-year time horizon from a US healthcare perspective. The base case was a 70-year-old with locally advanced, unresectable pancreatic cancer, common bile duct dilation &gt;15 mm, and MDBO. Probabilities were derived from meta-analyses of randomized trials. Outcomes were incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay (WTP) threshold of $100 000\/quality-adjusted life year (QALY). Extensive sensitivity analyses were performed.<\/jats:p>\n                  <jats:p>EUS-CDS with LAMS was cost effective versus ERCP-BD with SEMS for primary treatment of\n        MDBO at an ICER of $47 711\/QALY. In one-way sensitivity analyses, EUS-CDS remained cost\n        effective if it cost &lt;$15 502 or if ERCP-BD cost &gt;$11 174. ERCP-BD would become cost\n        effective if technical success was &gt;91%, reintervention &lt;11%, or postprocedural\n        pancreatitis &lt;4%. Probabilistic sensitivity analysis showed EUS-CDS remained cost\n        effective in 74.1% of iterations at a $100 000\/QALY WTP threshold.<\/jats:p>\n                  <jats:p>In patients with MDBO and biliary dilation &gt;15 mm, EUS-CDS with LAMS may be not only a clinically preferred option but also an economically viable primary approach. Continued efforts to minimize LAMS costs, decrease stent dysfunction, and identify optimal anatomic indications are warranted to facilitate wider adoption.<\/jats:p>","DOI":"10.1055\/a-2837-1405","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:18:20Z","timestamp":1774570700000},"page":"963-974","source":"Crossref","is-referenced-by-count":1,"title":["Endoscopic ultrasound versus endoscopic retrograde cholangiopancreatography for primary palliation of malignant distal biliary obstruction: a cost\u2013effectiveness modeling analysis"],"prefix":"10.1055","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2083-3398","authenticated-orcid":false,"given":"Patrick T.","family":"Magahis","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital, Massachusetts, United States","place":["Boston"],"department":["Department of Medicine"]},{"name":"New York-Presbyterian Hospital\/Weill Cornell Medicine, New York, United 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Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hanscom","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital\/Weill Cornell Medicine, New York, United States","place":["New York"],"department":["Division of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartik","family":"Sampath","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital\/Weill Cornell Medicine, New York, United States","place":["New York"],"department":["Division of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Carr-Locke","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital\/Weill Cornell Medicine, New York, United States","place":["New York"],"department":["Division of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3235-6904","authenticated-orcid":false,"given":"Reem Z.","family":"Sharaiha","sequence":"additional","affiliation":[{"name":"New York-Presbyterian Hospital\/Weill Cornell Medicine, New York, United States","place":["New York"],"department":["Division of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/BF02712816","article-title":"Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage","volume":"7","author":"M Porta","year":"2005","journal-title":"Clin Transl Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1097\/MCG.0b013e318272440e","article-title":"Effect of endoscopic stenting of malignant bile duct obstruction on 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